1. Reference:
1. 2006-2008 SPARCS data. New York State Department of Health 2010 from www.nyhealth.
gov/statistics/ny_asthma
2. Krieger, James, Lin Song, Timonthy Takaro, and James Stout. “Asthma and the
home environment of low-income urban children: Preliminary findings from the Seattle-King
country healthy homes project.”Journal of Urban Health: Bulletin of the New York Academy of
Medicine. 77. no. 1 (2000): 50-67. 10.1007/BF02350962 (accessed March 1, 2013).
3. Lwebuga-Makasa, J. Dunn-Georgiou, E. (2002). A School-Based Asthma Intervention Pro
gram. Journal of School Health, 72(1) 27-32.
4. Stanton, M.W., Dougherty, D. (2005) Chronic Care for Low-Income Children with Asthma:
Strategies for Improvement. Research In Action 2005; AHRQ Pub. No. 05-0073
5. “National Prevention Strategy,” last modified June 11, 2011 HealthCare.gov http://www.
healthcare.gov/prevention/nphpphc/strategy/index.html
Conclusion:
• Home visits are found to be an effective tool for asthmatic children to provide tools to families
regarding effective asthma self-management.
• Participants in the program were receptive to home visits by nursing students and CHW.
• Participants in the program demonstrating increase use of structured medical interventions
with support systems in place and decreased use of urgent/emergent services.
• Home visits provided to the participants allowed the program to assist participants evaluate
their health and environmental habits and create a systematic individualized plan to address
issues.
• Providing an agency medical letter to landlords to partner with them to address structural
issues provided participants support and addressed advocacy needs without jeopardizing
current housing.
• Participants who were home owners often were not aware of the amount of resources
available to assist addressing structural issues at free or reduced cost.
• Program provision of advocacy and referral services provided participants a sense that they
were being supported in addressing overwhelming issues.
Time Lines and Activities
0
50
100
150
200
250
300
350
400
14215 14213 14202 14201 Erie County AverageRate
Asthma Rate
Erie County
Average
Asthma
Rate
Community Based Comprehensive Asthma Management
Lauraine A. Neal, RN, MS NEd, ACHNE & Alexis Soto-Colorado, AICP, MUP, MTou
D’Youville College School of Nursing, Buffalo, NY
Introduction
The Asthma Intervention, Resources and Environmental (AIR-E)
Management Program was created as a collaboration between the Belle
Center (located on the West Side of Buffalo NY) and D’Youville College
School of Nursing as a method to collaborate services to reach Asthma
affected children ages 0-17 years old and offer:
• A systematic plan of screening
• Assessment of clients and their home environment
• Provision of an Asthma kit, education regarding kit
• Re-evaluation of asthma status and environment status
on follow-up home visits
As the program has evolved it was noted that further management
systems would be required. Additional partnerships with the D’Youville
College of Pharmacy was created to target education of Asthma
affected patients/children in both inpatient and outpatient setting, also
partnerships were created with the Buffalo Public schools so that larger
populations of children affected with Asthma could be reached.
The goals of AIR-E program are to demonstrate the critical steps in
creating clinical innovations to address community needs through:
• Community assessments,
• Provide methods to partner with community agencies to increase the
impact of the college/university based programs and
• Create methods to track data, improve program operations and
achieve program outcomes.
Goals
• Child’s asthma is under control as shown by no hospitalizations or
emergency department visits for asthma in three months
• No school absences due to asthma in past month
• Child has one specific medical provider for asthma (primary care or
specialist)
• Child has medical insurance
• Child has an Asthma Action Plan completed
• Child has appropriate preventive medications and takes them
appropriately
• Family has reduced indoor asthma triggers
• Family has become self reliant in accessing needed supportive
services
Method and Material
D’Youville College School of Nursing Community Home
Based Program provided participants with baseline spirometry
testing, home assessment of environmental triggers, creation
and provision of asthma action plan, asthma journal, and
asthma kit, repeat spirometry testing post interventions,
referral service for home weatherization/remediation and
tenant advocacy if needed. Learning styles utilized for
program were, applied learning, use of multiple levels of
environments for learning, assessment and incorporation
of diverse learning styles and provision of service learning
opportunities for nursing and pharmacy students.
To determine the population to serve, community
assessments were conducted in addition to obtain New York
State data to determine zip codes in which the severest cases
resided.1,3
Students received extensive training on asthma
and home assessments. Students were also partnered with
Community Health Workers (CHW’s) to aid in bridging the
gap in health care provision and navigation of community
Nursing students conducting home
assessment as part of the training from
the Master Home Enviornmental course
from the American Lung Association.
Housing condition of vacant home
that the students evaluated, multiple
triggers noted such as lead, mold,
leaky windows. This house is under
renovation from the program Heart of
the City in Buffalo New York that cre-
ates home ownership opportunities to
low-income families.
Asthma rate according to location in Buffalo, NY. 1
Results
• Participants in the program found that they did not have
sufficient knowledge regarding indoor air quality and its
impact on the asthma affected persons’ health.
• Participants were more aware of highly visible asthma
triggers such as mold, moisture, mildew, roach/mice
droppings but less aware of environmental impact on
child’s asthma due to choice of cleaning products, cleaning
regimen, and frequency of cleaning.
• Participants expressed concern when living in tenant-
landlord properties and notifying authorities of living
violations.
• Many participants felt they would be evicted and because of
this issue, chose to continue living in substandard housing
that was affordable.
• Participants’ caregiver expressed poor use of controller
medication because it (the medication) did not provide the
same immediate relief of symptoms and often felt like they
were “not taking anything at all so why bother taking the
(controller) medication.”
• Participants expressed difficulty accessing provider for relief
from symptoms and quick intervention. They were often
told they had to bring child in for an evaluation. Due to work
schedule participants often went long periods without seeing
provider for asthma intervention and utilized ER when child’s
asthma became severe.
Asthma Rate prevalence according to zip code in Buffalo New York in comparision to
the average in Erie County, NY.1
Hypothesis
Asthma Intervention, Resources and Evironmental Management
program (AIR-E) used the National Prevention Strategy Framework
(NPSF) which was created to shift the nation from a focus on sickness
and disease to one based on prevention and wellness. This strategy
was developed by the National Prevention, Health Promotion and Public
Health Council with input from the Federal Advisory Group Prevention,
Health Promotion, and Integrative and Public Health. This group is
called “The Strategy” which includes a vision, goal, pillars, priorities and
recommendations to help guide the Federal government and the nation
on the most effective and achievable means for improving the health
of Americans through prevention and health promotion policies and
programs. 5
The vision of NPSF promotes organizations to work together
to improve the health and quality of life for individuals, families, and
communities by moving the nation from a focus on sickness and disease
to one based on prevention and wellness.
Acknowledgment:
Master Home Environmentalist & HEAL II Tool:
The MHE is a unique program that was developed in 1992 to promote human health by
increasing awareness of home environmental pollutants and to encourage actions to reduce
exposure. Program results indicate an 87% improvement with individual behaviors.2
The Home EnvironmentalAssessment List – II (HEAL-II) was developed by the Master
Home Environmentalist program. Training consists of 100 hours of didactic and field
learning and includes instruction on interviewing skills, use of the interview instruments,
asthma pathophysiology, and identification and control of asthma triggers.
The MHE HEAL II was based on a review of models of determinants of asthma morbidity
and a general model of the physical, biological, and social determinants of health.
Consultation was received in its development from the NationalAsthma Education and
Prevention Program (NAEPP) and Global Initiative forAsthma guidelines, and emphasized
inclusion of topics addressed by Healthy Homes protocols.2
Asthma Rate in Buffalo, NY
Asthma Rate in Buffalo, NY
Colloborating Organizations:
RochesterAmerican LungAssociation Community Foundation of Buffalo – Green Healthy Home Initiative
Holy Cross Headstart Bethel Headstart
Belle Center, Buffalo, NY Buffalo Public School Systems
D’Youville School of Pharmacy Community Health Worker Network of Buffalo